In occupational rehab, understanding the real demands of a client’s role is key to designing effective programs and achieving successful RTW (return to work) outcomes. While clients can describe their tasks, sometimes it takes seeing those movements and tasks in action – and maybe even trying them ourselves! – to truly understand what’s required.
Recently, one of our Exercise Physiologists, Caitlin, experienced this firsthand during a worksite visit for a client in New Zealand. What she observed on site significantly reshaped her exercise prescription and added valuable insight into his fatigue management needs. We checked in with her to gain her insights on the value it provided for her exercise physiology program.
Gary’s Story – A Complex Medical Journey
Gary (name changed for privacy) was referred by his life insurer in NZ to support his return to work after a serious medical event:
“He’d had a celiac artery dissection and rupture, which put him in hospital for about two to three weeks. He was really lucky to survive. His internal organs were deprived of oxygen for a significant amount of time and he was left with ongoing fatigue and a hernia developing in a really awkward location close to the ruptured artery.”
Before his injury, he held a demanding dual role as both CEO and hands-on car manufacturer and fabricator, rebuilding vintage cars. His work involved heavy physical tasks, like welding and manipulating large metal sheets, alongside the cognitive and social load of managing a business.
“His body had been through a really significant trauma when I met him initially, a lot of high stress. He was very high up within the company in terms of responsibilities and load on him. So it sounded he had been working in that ‘sympathetic high stress’ load for a long time. This was the health issue that was the cherry on the cake to tell his body that enough is enough.”
At the time of referral to EP Caitlin, Gary had not yet returned to work. The insurer’s request focused on having us help him manage fatigue, restore functional capacity and start building work readiness in preparation for a return to his role.
What We Imagine vs. The Reality
“When he told me he was a car fabricator, my first question was, what on earth is that? I had these ideas in my head of what that looked like on a daily basis – maybe some welding at waist level, pushing a sheet of metal through a roller, working on the ground.”
Caitlin designed a program based on his verbal descriptions. But as she soon discovered, what clients describe and what clinicians picture can be quite different.
“I didn’t really realize how big the metal would be – these bits of ply and bits of metal were about two of my arm spans wide. The big welding gun actually weighs about 20 kilos and he has to stand with it and have his shoulders elevated, moving it back and forth at head level. It changed my whole exercise prescription because I was imagining the movement down low. And seeing how far he has to walk between the two workshops made me understand what he meant when he said to me that he’s on his feet all day. It was a lot further than I realized.”
The real shock came when she had the chance to feel them for herself too!
“When he told me he was pushing down on a pedal with his foot while welding… I had to try it myself – it was ridiculously hard to press!”
Shaping The Exercise Prescription
These in person observations gave Caitlin a crystal clear picture of his physical demands in the workplace: sustained upper limb endurance at elevated positions, lifting heavy and wide loads, walking endurance and task-specific lower limb strength.
“I was giving him a resistance band push down to start with, and no wonder he found it super easy because what he had to do was completely different to what I was thinking. Seeing it and me doing it myself changed my whole exercise prescription – I could make my exercise prescription a lot more specific to the exact tasks he needs to do at work.”
Understanding the Environment
Worksite visits don’t just reveal physical demands – they also offer insight into the work environment, psychosocial factors and how clients interact with their colleagues and clients.
With Gary’s consent, Caitlin spoke to his team.
“I asked some of the guys in his team how he is doing at work. They said that they can tell that he is fading around 2 or 3pm in the afternoon, so they try to remind him to take breaks. He’s one of those clients you need to pull back on, rather than trying to get him to do more. It’s good, because sometimes you don’t notice things in yourself that others do.”
This feedback from his colleagues highlighted the presence of cognitive fatigue, which was critical given the precision required in his work. Errors in cutting metal could be costly, so afternoon fatigue posed both a safety and productivity risk. This information allowed Caitlin to incorporate fatigue management strategies into his rehabilitation plan, ensuring he could pace effectively and manage his energy across the day.
Why This Matters For RTW Programs
For referrers in the workers compensation, life insurance and wider occupational rehab world, this case highlights why worksite visits by EPs are invaluable:
- They bridge the gap between what’s described and what’s real,
- They let clinicians feel and see the demands of work tasks first hand,
- They enable precise tailoring of exercise programs to actual job requirements,
- They provide rich insight into environmental and psychosocial factors, informing strategies beyond physical rehab.
By stepping into the client’s world, Caitlin was able to build a targeted, realistic rehabilitation plan that addressed both physical and cognitive demands – ultimately supporting a safer and more sustainable RTW.
Do you have a client that would benefit from an in-person worksite visit to inform the exercise prescription? Reach out for a chat!
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